Prognostic impact of histological review of high-grade endometrial carcinomas in a large Danish cohort
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Prognostic impact of histological review of high-grade endometrial carcinomas in a large Danish cohort. / Boennelycke, Marie; Peters, Elke E.M.; Léon-Castillo, Alicia; Smit, Vincent T.H.B.M.; Bosse, Tjalling; Christensen, Ib Jarle; Ørtoft, Gitte; Høgdall, Claus; Høgdall, Estrid.
I: Virchows Archiv, Bind 479, Nr. 3, 09.2021, s. 507-514.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Prognostic impact of histological review of high-grade endometrial carcinomas in a large Danish cohort
AU - Boennelycke, Marie
AU - Peters, Elke E.M.
AU - Léon-Castillo, Alicia
AU - Smit, Vincent T.H.B.M.
AU - Bosse, Tjalling
AU - Christensen, Ib Jarle
AU - Ørtoft, Gitte
AU - Høgdall, Claus
AU - Høgdall, Estrid
N1 - Publisher Copyright: © 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2021/9
Y1 - 2021/9
N2 - The aim of this study was to investigate the outcome of histological subtype review of high-grade endometrial carcinoma (EC) and its prognostic impact in a large well-documented Danish nationwide cohort. From the Danish Gynecological Cancer Database (DGCD) 2005–2012 cohort, we included 425 patients with an original diagnosis of high-grade EC, independent of histologic subtype. Of these, at least one hematoxylin and eosin (H&E)–stained slide from 396 cases (93.2%) was available for review. The histologic subtype was reviewed by specialized gynecopathologists blinded to the original diagnosis and clinical outcome. Interobserver variability between original and revised histologic subtypes was analyzed using simple Kappa statistics. Hazard ratios (HR), recurrence-free survival (RFS), and overall survival were calculated for original and revised subtypes, respectively. Overall histologic subtype agreement was moderate (kappa = 0.42) with the highest agreement for endometrioid-type EC (EEC; 75.5%) and serous-type EC (SEC; 63.8%). For clear cell carcinoma and un-/dedifferentiated EC, agreement was significantly lower: 30.1% and 33.3% respectively. Of the 396 reviewed cases, only two (0.5%) were re-classified as low-grade EEC upon revision. Interestingly, GR3 EEC had better RFS than SEC with stronger significance after revision (HR 2.36 (95% CI 1.43–3.89), p = 0.001), compared to original diagnosis (HR 1.74 (95% CI 1.07–2.81), p = 0.024). In conclusion, this study confirmed that pathology review results in substantial shift in histological subtype in high-grade EC. After review, a stronger prognostic benefit for GR3 EEC as compared to other histological subtypes was observed. This work supports maintaining a low threshold for pathology revision of high-grade EC in clinical practice.
AB - The aim of this study was to investigate the outcome of histological subtype review of high-grade endometrial carcinoma (EC) and its prognostic impact in a large well-documented Danish nationwide cohort. From the Danish Gynecological Cancer Database (DGCD) 2005–2012 cohort, we included 425 patients with an original diagnosis of high-grade EC, independent of histologic subtype. Of these, at least one hematoxylin and eosin (H&E)–stained slide from 396 cases (93.2%) was available for review. The histologic subtype was reviewed by specialized gynecopathologists blinded to the original diagnosis and clinical outcome. Interobserver variability between original and revised histologic subtypes was analyzed using simple Kappa statistics. Hazard ratios (HR), recurrence-free survival (RFS), and overall survival were calculated for original and revised subtypes, respectively. Overall histologic subtype agreement was moderate (kappa = 0.42) with the highest agreement for endometrioid-type EC (EEC; 75.5%) and serous-type EC (SEC; 63.8%). For clear cell carcinoma and un-/dedifferentiated EC, agreement was significantly lower: 30.1% and 33.3% respectively. Of the 396 reviewed cases, only two (0.5%) were re-classified as low-grade EEC upon revision. Interestingly, GR3 EEC had better RFS than SEC with stronger significance after revision (HR 2.36 (95% CI 1.43–3.89), p = 0.001), compared to original diagnosis (HR 1.74 (95% CI 1.07–2.81), p = 0.024). In conclusion, this study confirmed that pathology review results in substantial shift in histological subtype in high-grade EC. After review, a stronger prognostic benefit for GR3 EEC as compared to other histological subtypes was observed. This work supports maintaining a low threshold for pathology revision of high-grade EC in clinical practice.
KW - Endometrial carcinoma
KW - High grade
KW - Histology
KW - Prognosis
KW - Revision
U2 - 10.1007/s00428-021-03133-2
DO - 10.1007/s00428-021-03133-2
M3 - Journal article
C2 - 34117532
AN - SCOPUS:85107803694
VL - 479
SP - 507
EP - 514
JO - Virchows Archiv
JF - Virchows Archiv
SN - 0945-6317
IS - 3
ER -
ID: 303774015